A RECALCITRANT SKIN LESION AND SUBSEQUENT INFECTION IN A RECREATIONAL INTRAMURAL MALE ATHLETE: A CASE REPORT.

A 35-year-old intramural male athlete presented to the athletic training staff with a 4.5cm x 2.2cm itchy, painful, swollen, and infected insidious skin lesion on his right lateral malleolus due to an underlying dermatological deficiency. Suspecting infection, the patient was referred to his nurse practitioner and was diagnosed with atopic dermatitis caused by a ceramide deficiency. He was placed on Cefalexin and Mupirocin 2% ointment but returned due to the lesion increasing to 8.5cm x 6cm although infection seemed controlled. He was instructed to use Ceravé™ topical cream, Clobetasol propionate 5%, and consume foods rich in healthy oils (omega-3s, olive oil). Unmitigated, this lesion could have resulted in severe infection and tissue damage. Atopic dermatitis is relatively common in the general population but the appearance in healthy athletes highlights that athletic trainers need to be well-versed in not just apparent causes of skin ailments (i.e., infection), but also root causes.

Celiac Disease Symptoms in Athletes: Prevalence Indicators of Perceived Quality of Life.

BACKGROUND: Celiac disease (CD) is a common gastrointestinal pathology; however, prevalence and comorbidities are unknown in collegiate athletics. HYPOTHESES: (1) Athletes will have similar odds of CD as general population estimates (approximately 1 in 141) based on self-report and signs and symptoms, (2) athletes scoring higher on the Celiac Symptom Index (CSI) will have lower self-reported quality of life (QoL), (3) athletes scoring higher on the CSI will have higher depression scores, and (4) athletes scoring higher on the CSI will have higher perceived stress scores. STUDY DESIGN: Epidemiological cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: The CSI, WHO Quality of Life-BREF, Beck Depression Inventory, and Perceived Stress Scale were used to assess patients' signs and symptoms of CD and psychosocial measures/QoL in male and female National Collegiate Athletic Association (all divisions) athletes (N = 141). Participants also self-reported a formal diagnosis of CD. Chi-square analyses determined CD prevalence. Odds ratios determined risk for either being diagnosed with CD or reporting more symptoms than the general population. Correlational analyses determined whether symptoms correlated with QoL and psychosocial measures. RESULTS: Athletes were 3.85 times (95% CI, 0.42-34.89) more likely to report a CD diagnosis and were 18.36 times (95% CI, 2.40-140.48) more likely to report a high degree of CD symptoms than the general population. Athletes with more symptoms had worse physical, psychological, social, and environmental QoL indicators and higher depression and perceived stress scores. CONCLUSION: Athletes may be a higher risk population for experiencing CD and report greater signs/symptoms compared with general population estimates. Additionally, athletes with higher CD symptom scores also reported poorer QoL. CLINICAL RELEVANCE: Allied health care professionals should be aware of the diversity of CD symptoms and be prepared to refer athletes when gastrointestinal symptoms persist to ensure proper care and unhampered performance.

"Off-Label" Usage of Testicular Self-Examination (TSE): Benefits Beyond Cancer Detection.

Testicular cancer (TCa) is the most common cancer among 15- to 34-year-old males. Treatments are highly effective, which help foster approximately 98% 5-year survival rate. There are very few known causal factors of the disease (e.g., cryptorchidism and family history), thus possibly limiting primary prevention methods. Secondary preventative measures, on the other hand, most notably testicular self-examination (TSE), are well-known and are promoted to help prevent late-stage diagnosis of TCa. However, debate ensues as to whether or not TSE provides any benefit. In light of a recent systematic review conducted by these authors assessing the effectiveness of TSE promotion interventions, we propose that the behavior can serve as a tool not just for detection of TCa, but other male-specific urogenital health concerns, including varicoceles, hydroceles, among others. Furthermore, we suggest that TSE can also help foster informed decision-making skills among males with regard to health concerns and treatment options. However, our advocacy is in direct conflict with U.S. Preventive Services Task Force's influential "D" rating of TSE and others who recommend against performing TSE. This article offers an overview of the dispute over TSE's purpose and net benefit. We conclude that TSE is a behavior that is beneficial beyond detecting cancer. These proposed "off-label" uses of the procedure make for an effectual means to promote testicular health, self-awareness, and wellness among males. Recommendations for future research and advocacy are presented to the academy.

Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care.

The phrase "standard of care" is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official "exclusion" from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.

A Call for Gender-Inclusive Global Health Strategies.

The WHO's "Global Strategy for Women's, Children's, and Adolescents' Health 2016-2030" (GS-WCAH 2016-2030) is a comprehensive plan developed to improve the lives of women, children, and adolescents. Due to the success in the creation, ratification, and advocacy of the GS-WCAH 2016-2030, the clear health outcome disparities between males and females, and the general absence of male health from existing policies and sponsored programs, it is time now to develop a global strategy specifically drafted to improve the lives of men and boys. The following commentary provides three points for why a male-oriented program, like the GS-WCAH 2016-2030, should be created: (a) health outcomes disparities, (b) economic impact of poor male health, and (c) fathers' role in promoting the health of women, children, and adolescents. Implications for how male health can be incorporated into future projects and priorities are provided, as well as advocacy for overall gender-inclusivity in regard to global public health efforts.

Development and Testing of a Conceptual Model Regarding Men's Access to Health Care.

Epidemiologic data suggest men often experience excessive morbidity and early mortality, possibly compromising family and community health over the lifespan. Moreover, the negative financial/economic consequences affected by poor male health outcomes also has been of great concern in the United States and abroad. Early and consistent access to preventative health care may improve health outcomes; however, men are far less likely to access these services. The purpose of this study was to understand what factors preclude men from accessing health care. We surveyed 485 participants using a 58-item online survey built from a conceptual model previously developed by the researchers using hegemonic masculinity theory, the theory of normative contentment, and the health belief model. For men, three items significantly ( ps < .05) predicted whether they had seen a health care provider in the past year: "I/Men do not access healthcare because I do not think there is anything wrong with me," "My health is only about me," and "I/Men do not access healthcare because most men in my family do not access healthcare." Other correlations of practical significance also were noted. Results suggest gender norms and masculine ideals may play a primary role in how men access preventative health care. Future programming targeting males should consider barriers and plan programs that are gender-sensitive in addition to being gender-specific. Clinical implications are discussed.

Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report.

OBJECTIVE: To discuss the case of a 49-year-old man who presented to the sports medicine staff with pelvic pain of 10 years' duration consistent with pudendal neuralgia. BACKGROUND: Testicular pain in men is often provoked by direct trauma or may indicate an oncologic process. DIFFERENTIAL DIAGNOSIS: Epididymitis, athletic pubalgia, testicular tumor, sacroiliac joint dysfunction, lumbar radiculopathy. TREATMENT: The patient responded positively to treatment and rehabilitation to restore normal mechanics to the lumbo-pelvic-hip complex. Several flare-ups since the initial treatment have been of short duration (<2 days) and less intense. UNIQUENESS: Pudendal neuralgia tends to affect females more than males due to changes in the alignment and stability of the pelvis from a combination of a shorter, wider pelvis and muscle imbalances associated with childbirth. Typically, males with testicular pain suffer from epididymitis or some type of testicular torsion, which was not the situation in this case. Compression is also a common cause of pudendal neuralgia, although it was not responsible for this patient's pain, making diagnosis and treatment complex. CONCLUSIONS: Many pain syndromes can be treated with removal of the original stimulus. However, recognizing the factors contributing to pelvic pain and dysfunction in males can be a challenge for the sports medicine professional. A vigilant and unassuming approach to male pelvic pain is warranted, particularly by health care providers in diverse practice settings.

From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening.

In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a 'D' recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the 'D' grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a 'D' grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current 'D' grade for TCa screening (i.e. discourage the use of said service) should be changed to an 'I' statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.

Interventions Promoting Testicular Self-Examination (TSE) Performance: A Systematic Review.

Testicular cancer is one of the greatest threats to health and wellness among 15- to 40-year old males. A concerted effort in the literature promoting awareness, risk factors, and preventative measures is warranted. There is limited discussion on the validity of interventions aimed at promoting testicular self-examination (TSE) performance; the existing body of evidence offers little discussion on what specific factors motivate performance. To assist in making Healthy People 2020 an all-inclusive success, a comprehensive assessment of existing evidence is necessary to assist in closing this research gap. A systematic review of interventions promoting TSE performance discovered moderate levels of effectiveness among 10 studies promoting the behavior. Concerning methodological quality, nine were of average quality and one was of high quality. In terms of significant TSE reporting between intervention and control/comparison groups, 3 out of 10 did not achieve the statistical causal threshold. Based on our assessment of TSE intervention quality and outcomes pertaining to behavior adoption, a best-practices guideline is presented for researchers in the field to consult as they design their interventions. This guideline aims to improve on internal and external validity of TSE promotion research in order to make them more effective.

The adolescent body image satisfaction scale for males: exploratory factor analysis and implications for strength and conditioning professionals.

The purpose of this study was to determine whether there is evidence of reliability and validity for the Adolescent Body Image Satisfaction Scale (ABISS), an instrument previously developed to measure adolescent body image. A sample (N = 330) of adolescent males, aged 14-19 years, completed the ABISS to determine current body image satisfaction. Data were analyzed for measures of instrument composite reliability and initial content and construct validity. Exploratory factor analysis supported a 3-factor solution (16 total items), which explained 42.7% of variance in the model. Composite reliability for the subscales, body competence, body inadequacy, and internal conflict ranged from 0.64 to 0.82. Exploratory factor analysis of the ABISS provides initial psychometric support for a valid and reliable measure for assessing adolescent male body image, which also can be used as a needs assessment tool. Strength and conditioning professionals should be aware of their athlete and client psychological attributes, many of whom are adolescents. Understanding how adolescents view their bodies and their body image will assist professionals in designing appropriate, health-promotive strength programs, while at the same time monitoring for signs of body image dissatisfaction. Assessing body image can help heighten awareness and possibly encourage preventative programming to help avert negative health practices (e.g., performance-enhancing drug use, exercise addictions, disordered eating). The ABISS seems to have preliminary psychometric support to be a valid and reliable instrument that helps gauge at-risk populations.

"Normative content" and health inequity enculturation: a logic model of men's health advocacy.

Epidemiologic studies and related literature consistently report that males have fewer years of life expectancy than females. Moreover, males experience fewer quality years of life in that they tend to live with greater rates of morbidity such as heart disease, cancer, and diabetes among other conditions. Causal evidence traditionally highlights the role of biology in determining the life course for males. However, emerging literature suggests that social determinants of health play a more central role in male morbidity and mortality, and thus contribute to health inequities between the sexes. The purpose of this article is to explore core concepts of social determinants of health as they pertain to male health inequities and provide a systematic conceptualization of how society has become encultured to view these inequities as "normative." Strategies to improve male health are discussed using a logic model to illustrate male health advocacy in the face of the social climes of encultured health inequities.

Older adult perceptions of the physicians' role in promoting physical activity.

PURPOSE: The purpose of this research was to explore the perceptions of independent living older adults regarding their physicians' role in promoting physical activity (PA). METHODS: A qualitative inductive analysis was undertaken using focus group discussions of independent living adults over age 60. Thirty-one participants were placed into focus groups based on their current level of PA (three focus groups of physically active persons, and three focus groups of physically inactive persons). Discussions were audiotaped and transcribed verbatim. Qualitative data were open and axially coded and independently analysed by two researchers for emergent themes. Inter-rater reliability was established (κ = 0.89). RESULTS: Themes for physically active and physically inactive groups included limited or inadequate discussions with their physician regarding PA, and the use of PA as a secondary prevention method. The physician as an extrinsic motivator of PA emerged only in the physically active group discussions. Some participants believed that their physician was uncomfortable discussing PA or that their physician was unable to provide them with sufficient PA guidelines. When PA counseling occurred, it was usually in relation to a preexisting illness. DISCUSSION AND CONCLUSION: Although participants were looking to their physician for PA counseling, physicians were not initiating a regular PA dialogue. Possible reasons may include lack of physician knowledge or skill. Further research is needed to explore physicians' knowledge and comfort when prescribing exercise or PA for their patients.

National Athletic Trainers' Association position statement: anabolic-androgenic steroids.

OBJECTIVE: This manuscript summarizes the best available scholarly evidence related to anabolic-androgenic steroids (AAS) as a reference for health care professionals, including athletic trainers, educators, and interested others. BACKGROUND: Health care professionals associated with sports or exercise should understand and be prepared to educate others about AAS. These synthetic, testosterone-based derivatives are widely abused by athletes and nonathletes to gain athletic performance advantages, develop their physiques, and improve their body image. Although AAS can be ergogenic, their abuse may lead to numerous negative health effects. RECOMMENDATIONS: Abusers of AAS often rely on questionable information sources. Sports medicine professionals can therefore serve an important role by providing accurate, reliable information. The recommendations provide health care professionals with a current and accurate synopsis of the AAS-related research.

Predictors of adolescent male body image dissatisfaction: implications for negative health practices and consequences for school health from a regionally representative sample.

BACKGROUND: Adolescent males are more likely to sustain intentional and unintentional injuries, be involved in a physical confrontation, and be successful in suicide attempts. Body image dissatisfaction (BID) has been linked as a possible contributing factor to these negative health behaviors and risks; however, research is limited with males. The interaction of intrapersonal, interpersonal, and social variables in a holistic model has yet to be explored for males. Variables precipitating adolescent males to develop an unhealthy body image and act on negative health behaviors, such as body image drug use, were the impetus for this study. METHODS: A randomized cross-sectional sample of 330 adolescent males answered questions concerning body image using the Adolescent Body Image Satisfaction Scale (ABISS). Pearson product moment correlations and stepwise regression analyses identified the strongest predictive variables of BID. RESULTS: The strongest contributing variables accounting for 56.7% of model variance were desire for the body of another person (r = .571, p < .001), teasing (r = .490, p < .001), satisfaction with their body when they were younger (r = .450, p < .001), and difficulty coping with criticism (r = .443, p < .001). No statistically significant differences were found for racial/ethnic background (p < .822, n.s.). CONCLUSIONS: Educators and school districts should consider the confluence of psychosocial variables affecting body image and adolescent male health risk behaviors based on a statistically sound predictive model as provided by the ABISS. Targeted programming to enhance body image and address teasing/bullying behaviors is strongly recommended.

Autoimmune dysfunction and subsequent renal insufficiency in a collegiate female athlete: a case report.

OBJECTIVE: To present the case of a female collegiate basketball player who was diagnosed with Wegener granulomatosis of the eyes and immunoglobulin A (IgA) nephropathy. BACKGROUND: A 19-year-old female collegiate basketball player presented to a rheumatologist, urologist, and nephrologist with severe eye pain and was diagnosed with Wegener granulomatosis and IgA nephropathy. At age 20, during routine follow-up testing, urine protein levels were found to be 3 times normal values (0-8 mg/dL), prompting the need for a kidney biopsy, which showed IgA nephropathy, another autoimmune disorder. DIFFERENTIAL DIAGNOSIS: Sinus infection, scleritis, lymphomatoid granulomatosis, Churg-Strauss syndrome, lupus erythematosus, general granulomatosis. TREATMENT: Initial assessment revealed signs and symptoms, particularly in the patient's eyes, consistent with a sinus infection and scleritis. Her corneas were examined by a specialist, who prescribed various medications, including prednisone, for the relief of symptoms. When the dosage of prednisone was reduced, symptoms returned. Further tests revealed the presence of anti-neutrophil cytoplasmic antibody, a protein associated with Wegener granulomatosis, which helped confirm the diagnosis. The following year, a routine urinalysis showed abnormal levels of protein in her urine. A kidney biopsy revealed that IgA nephropathy also was present. At the time of this case report, the athlete continues to be monitored by an ophthalmologist who specializes in Wegener granulomatosis, a rheumatologist, and a nephrologist. UNIQUENESS: This athlete presented with 2 rare autoimmune disorders at an early stage of life. The medications used to treat the disorders left the athlete fatigued on a daily basis. Additionally, she was placed on 3 immunosuppressant drugs, which increased her risk for further health complications, yet she was able to successfully compete in athletics at the collegiate level. No family history of renal disease or other autoimmune disorders was discovered, further adding to the complexity and uniqueness of this case. CONCLUSIONS: Autoimmune disorders, such as Wegener granulomatosis, can present with a variety of common signs and symptoms. As athletic trainers, we encounter a host of unusual signs and symptoms; however, in cases such as this, further investigation into the cause of the chief complaints can go a long way toward restoring or managing an athlete's health. Excellent communication among the sports medicine team helped this athlete manage her potentially life-threatening condition while allowing her to remain active in her sport.

The effects of multiaxial and uniaxial unstable surface balance training in college athletes.

The purpose of this study was to compare the effects of 2 different types of unstable surface balance training (uniaxial on a rocker board [RB] and multiaxial on a dynadisc [DD]) on balance in division 1 collegiate athletes in sports that are at high risk for ankle sprains. Subjects (n = 36) consisted of male soccer players and female volleyball and soccer players who were equally and randomly assigned to 1 of 3 groups (CON, DD, and RB). Balance training consisting of balancing on 1 leg on either the RB or DD, while repeatedly catching a 1-kg ball was performed 3 times per week for 4 weeks. Balance was tested with the Star Excursion Balance Test (SEBT) before, halfway through, and at the completion of the balance training. Control (CON) subjects also were given the balance test but did not participate in the training. A 3-way repeated analysis of variance revealed that no group individually changed SEBT scores from pre (CON, 0.98 +/- 0.086; DD, 0.98 +/- 0.083; RB, 0.97 +/- 0.085) to post (CON, 1.00 +/- 0.090; DD, 1.01 +/- 0.088; RB, 1.02 +/- 0.068) after balance training. When the 2 treatment groups were combined (DD and RB), the p value decreased and came closer to significance (p = 0.136). When all 3 groups were combined, there was a significant difference in SEBT scores from pretraining (CON + DD + RB; 0.98 +/- 0.085) to posttraining (CON + DD + RB; 1.01 +/- 0.082), which likely indicates low statistical power. The increase in physical activity the subjects experienced during the return to in-season activity, may have contributed to the significant differences in SEBT scores over time but not between DD or RB training. Therefore, a threshold level of physical activity may exist that is necessary to maintain balance during the off-season.

Muscle dysmorphia symptomatology and extreme drive for muscularity in a 23-year-old woman: a case study.

We describe a 23-year-old woman with muscle dysmorphia symptomatology and extreme drive for muscularity. In addition to structured case study interviews, 3 questionnaires and a series of semistructured interview questions were administered for elaboration on key issues. The case studies allowed for triangulation of data garnered from the questionnaires. Responses revealed high scores for drive for muscularity, moderate scores for the Adonis complex, and high scores for symptoms of muscle dysmorphia. Muscle dysmorphia and drive for muscularity are more prevalent in men; however, unique cases such as this need to be further explored both empirically and theoretically. Cross-cultural references are needed to assess the overall impact of global social influences. Instruments measuring muscle dysmorphia need to be devised and validated for women as well as men. The strength and conditioning professional needs to be both aware and vigilant in helping people affected with psychosomatic disorders such as muscle dysmorphia or exercise addiction.

Perceptions and attitudes toward androgenic-anabolic steroid use among two age categories: a qualitative inquiry.

We attempted to qualitatively investigate why men of 2 age categories have chosen not to use androgenic-anabolic steroids (AASs). Twelve men (22.28 +/- 1.38 years [group I] and 53.00 +/- 13.28 years [group II]) were selected on the basis of specific inclusion criteria, including age and fitness levels (i.e., "do you weight train?"). Subjects were classified in 1 of 2 categories-younger or older precluders-and were asked to complete 2 survey instruments before their participation. The Drive for Muscularity Scale (reliability 0.85) and Body Image Questionnaire were used to gain a better understanding of perceptions and motivations regarding health, fitness, and body image. A series of semistructured questions were used to enhance focus group discussion regarding attitudes. Questions were validated by a panel of experts in qualitative methods. Member checks were conducted to enhance trustworthiness of the data. Data were transcribed verbatim and analyzed with thematic open-coding techniques. Various behaviors were reported regarding body image. Emerging themes showed a clear demarcation between age categories. Younger subjects cited power, control, body image, and narcissism, whereas older subjects viewed AAS use as more of an athletic-based phenomenon, such as with performance enhancement, when asked about steroids. Groups were in agreement that media trends and perceptions of the ideal male body are becoming "superhuman" and unattainable without chemical means. Understanding attitudinal perspectives might help complement national data on AAS trends. Future investigations could help coaches and allied health professionals collaborate with each other, as well as with national groups and foundations, to devise more appropriate strategies in addressing this growing athletic and public health concern.

Recognition and treatment of muscle dysmorphia and related body image disorders.

OBJECTIVE: To present the reader with various psychobehavioral characteristics of muscle dysmorphia, discuss recognition of the disorder, and describe treatment and referral options. DATA SOURCES: We conducted a comprehensive review of the relevant literature in CINAHL, MEDLINE, SPORT Discus, EBSCO, PsycINFO, and PubMed. All years from 1985 to the present were searched for the terms muscle dysmorphia, bigorexia, and reverse anorexia. DATA SYNTHESIS: The incidence of muscle dysmorphia is increasing, both in the United States and in other regions of the world, perhaps because awareness and recognition of the condition have increased. Although treatment options are limited, therapy and medication do work. The primary issue is identifying the disorder, because it does not present like other psychobehavioral conditions such as anorexia or bulimia nervosa. Not only do patients see themselves as healthy, most look very healthy from an outward perspective. The causes of muscle dysmorphia are not well understood, which reinforces the need for continued investigation. CONCLUSIONS: Muscle dysmorphia is an emerging phenomenon in society. Pressure on males to appear more muscular and lean has prompted a trend in the area of psychobehavioral disorders often likened to anorexia and bulimia nervosa. Athletes are particularly susceptible to developing body image disorders because of the pressures surrounding sport performance and societal trends promoting muscularity and leanness. Health care professionals need to become more familiar with the common signs and symptoms of muscle dysmorphia, as well as the treatment and referral options, in order to assist in providing appropriate care. In the future, authors should continue to properly measure and document the incidence of muscle dysmorphia in athletic populations, both during and after participation.

Celiac disease symptoms in a female collegiate tennis player: a case report.

OBJECTIVE: To present the case of a collegiate tennis player with celiac disease symptoms. BACKGROUND: Celiac disease is a common intestinal disorder that is often confused with other conditions. It causes severe intestinal damage manifested by several uncomfortable signs and symptoms. Failure by the sports medicine staff to recognize symptoms consistent with celiac disease and treat them appropriately can have deleterious consequences for the athlete. DIFFERENTIAL DIAGNOSIS: Irritable bowel syndrome, Crohn disease, Addison disease, lupus erythematosus, juvenile rheumatoid arthritis, lactose intolerance, herpes zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain syndrome, hyperthyroidism, anemia, type I diabetes. TREATMENT: The athlete underwent a series of blood and allergen tests to confirm or refute a diagnosis of celiac disease. When celiac disease was suspected, dietary modifications were made to eliminate all wheat-based and gluten-based products from the athlete's diet. UNIQUENESS: The athlete was able to fully compete in a competitive National Collegiate Athletic Association Division I tennis program while experiencing the debilitating effects associated with celiac disease. The immediacy of symptom onset was notable because the athlete had no history of similar complaints. CONCLUSIONS: Celiac disease is a potentially life-threatening condition that affects more people than reported. A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life.